Health care - administrative incompetence

[Rolfe]

Somehow, however, I doubt this is the case in actual practice in the UK and other places with socialized medicine. For example, is it possible to pay for a service yourself if the government denies the service? If so, then the rich still have better access to care and the poor are still denied services that might extend/better their lives, even if a government bean counter doesn't think it's worth it. So the system may cost less for the government to run, but can you really say it's gives all citizens equal access to medical care?

For example, a poor man who is alcoholic needs a new liver, but the government denies it because it isn't cost effective to give an alcoholic a new liver. He dies 6 months later. A rich man will also be denied the transplant, but he can simply pay for it out of his own pocket. He gets to live another 10 years or more. Even if it isn't allowed by law, he can still travel to another country where it is allowed.

Good grief, the amount of misconceptions in one short post! You obviously have the wrong end of the stick in a big way. I wonder what sort of propaganda is being fed to Americans, for people to think like this?

The government never denies anyone a service. What care you get is entirely in the hands of your doctor. The closest thing to a "bean counter" such as you envisage is NICE, and it's Scottish and Welsh counterparts. These organisations are committees of (OK, Government-appointed) top consultants who decide whether expensive new drugs are cost-effective. The aim is to avoid throwing money away on Big Pharma's latest money-spinner, not to deny people effective medication.

The sort of treatments that don't get approved by NICE are the hugely expensive anti-cancer drugs which don't cure but only prolong the dying process for a bit longer. When someone doesn't get something like that it tends to be big news and journalists write sob stories about it, but it's not a circumstance that ever affects the vast majority of the population. And if one person decides to ask for a judicial review (which is their right, because the health service belongs to US), and wins, then that's it - that drug is available to everyone else who needs it from then on.

I don't think you have any conception just how comprehensive the care provided by the NHS actually is. People are free to take out private medical insurance, or pay privately for procedures, but they usually only do that to get an elective procedure done at a time of their own choosing, and/or to go to a swankier hospital without the possibility of rubbing shoulders with the proletariat.

The decisions on who gets a transplant are taken entirely by the transplant co-ordinating teams, who decide on the basis of who needs any available organ most. You CANNOT pay for one.

There's a fair bit of agonising about how to share out scarce transplant organs, but alcoholics are not denied a transplant if they convince the transplant teams that they're off the sauce - not point in giving a liver to someone who'll just go right on drinking.

And of course they get it wrong sometimes. Look up the case of George Best, who got a new liver, was fine for a while, and then fell back off the wagon. I saw a TV programme about the decision-making process for liver transplantation, and one memorable case was a man with severe depression who had ODed on paracetamol. They decided to give him a liver. He absconded from a hospital some time later and jumped off Beachy Head.

The subsequent discussions were to the effect that if the committee was making the decisions about right, then there were bound to be cases like that. If this never happened it would suggest they were being too restrictive and possibly denying organs to people who would indeed benefit.

And the government has no say in any of this at all. They pay the doctors to take these decisions and treat the patients. Micromanagement is not what they do.

Rolfe.

 

[Agatha]

I can see that there might be a lot of benefits to going to a completely socialized medicine model. But it can't be a hybrid. It has to be equal access for all. Somehow, however, I doubt this is the case in actual practice in the UK and other places with socialized medicine. For example, is it possible to pay for a service yourself if the government denies the service? If so, then the rich still have better access to care and the poor are still denied services that might extend/better their lives, even if a government bean counter doesn't think it's worth it. So the system may cost less for the government to run, but can you really say it's gives all citizens equal access to medical care?

For example, a poor man who is alcoholic needs a new liver, but the government denies it because it isn't cost effective to give an alcoholic a new liver. He dies 6 months later. A rich man will also be denied the transplant, but he can simply pay for it out of his own pocket. He gets to live another 10 years or more. Even if it isn't allowed by law, he can still travel to another country where it is allowed.

The NHS doesn't deny any procedures on the grounds of cost, only on clinical need. For example, breast implants wouldn't be done for free for someone who just fancied a bigger pair, but someone who had had a mastectomy will get reconstruction surgery including implants.

Transplant surgery is done on the basis of clinical need and availability of organs. An alcoholic wouldn't be denied a transplant but they have had to have abstained from alcohol for six months (though this can be overriden by doctors) prior to being put on the transplant list. There is no private option for liver transplant surgery.

You can 'go private' for some things, but you don't get better care, you just get it at a time of your choosing (which may not be any quicker), your room may have a carpet, the food will be better and your fellow patients will be richer. You'll usually have the same doctors, though.

 

[Kestrel]

Good grief, the amount of misconceptions in one short post! You obviously have the wrong end of the stick in a big way. I wonder what sort of propaganda is being fed to Americans, for people to think like this?

We have several well funded think tanks in the US that are experts at using the techniques of modern advertising. The result is a rather incredible disconnect between public perception and reality.

 

[blutoski]

She may be covered under the auto policy of the owner of the car she was in when hit. The specific coverage is the "uninsured/underinsured liability". Provided that the car's owner has that coverage, and then the company has to agree that an unidentified driver = an uninsured driver (some companies try to fight that, reputable ones do not), and then subject to the coverage limits...but worth looking into. No sense paying for coverage if it's not used when needed.

(Public service announcement: a lot of people opt out of that coverage because they don't understand what it is--they see "uninsured" and think they're paying for the other guy. They're not. The coverage exists to cover you when they don't have insurance at all, because otherwise if they're at fault you'd have to sue them to recover your damages. It's usually very cheap coverage. Get it, and set the limits to the same as your regular liability. It's worth it because there are a lot of idiots out there!)

That's what I was thinking, but at this point I'm leaving it up to her lawyers to figure it out as I'm not very informed about US coverage with drivers' license.

We have a similar thing in BC up to something like $100k last I heard.

 

[jimbob]

Don't know about any of the other issues you raise, but are you sure about this part? I really don't know how to find statistics on this but anecdotally most people I know here really do not go to the doctor very often. It is more common for people to express a wish not to bother the doctor, and this is because we know they are busy and that minor stuff gets better by itself or with over the counter stuff. I don't think the decision to visit a doctor is much influenced by the lack of direct cost here.

You may be right but it is honestly not my impression: though the culture may well produce different results in the two countries, for all I know.

I can tell you from running a family practice clinic in the US (and consulting for many others) that overutilization is huge. People with Medicaid (state-provided insurance that provides free healthcare) come in every time their kid gets the sniffles or they have a headache. People with private insurance come in much less frequently because they don't want to pay the copay. Self-pay patients come in only when something is really wrong.

Maybe in the UK or other places with Socialized Medicine it's too much of a hassle to get an appointment with the doctor for minor things so people just skip it. Don't you have to wait a few weeks to actually get in to see a doctor? At our clinic, we will see a patient the day they call in most cases; we also accept walk-ins. So, for Medicaid and Medicare patients there is almost no barrier to access. Hell, even if they don't have a car, the government will pay for a van to bring them to their appointment!

The point remains that making people responsible for their own healthcare is the surest way to reduce utilization and therefore begin decrease costs.

I'd just add to Fiona's post that possibly because in the UK, the vast majority of healthcare is paid for out of taxes, I can't imagine that many people would think that going to the doctor could be a freebie. In the US, I'd imagine most people would be very aware of getting something for free, that costs other people a fair bit up front.

I can imagine that in the UK, there are certain people who do go to the doctor too often, but I'd guess they either need education, or some other support.

 

[TragicMonkey]

That's what I was thinking, but at this point I'm leaving it up to her lawyers to figure it out as I'm not very informed about US coverage with drivers' license.

We have a similar thing in BC up to something like $100k last I heard.

Auto insurance varies state-to-state, and of course it all depends on whether that coverage was purchased or not. But definitely needs to be looked into. With the coverage I have myself, if she'd been my passenger she'd have gotten $300K of it covered. (Although I'm also sure my insurer would have raised hell, $350K is outrageous unless they did amazing amounts of surgery. But the good part there is that instead of having to hire lawyers and investigators myself, my powerful insurance company would be unleashing its own paid hounds of hell upon that hospital.)

 

[blutoski]

I can tell you from running a family practice clinic in the US (and consulting for many others) that overutilization is huge. People with Medicaid (state-provided insurance that provides free healthcare) come in every time their kid gets the sniffles or they have a headache. People with private insurance come in much less frequently because they don't want to pay the copay. Self-pay patients come in only when something is really wrong.

Maybe in the UK or other places with Socialized Medicine it's too much of a hassle to get an appointment with the doctor for minor things so people just skip it.

Statistics show that accessibility to primary care is actually worse in the US than in Canada or the UK. ie: longer waits in the US for GP.

There are complex factors that go into this that produce ranging estimates. One important factor is that it's hard to describe Americans who are not covered by anything and also do not have the money for a cash visit. Are they part of the 'cannot access GP' equation? Are they 'waiting' for the rest of their lives? Or do they get deducted from the wait survey?

Many people argue that if the question is about access, people who want access but are unable to obtain it should be considered a negative.

Don't you have to wait a few weeks to actually get in to see a doctor? At our clinic, we will see a patient the day they call in most cases; we also accept walk-ins. So, for Medicaid and Medicare patients there is almost no barrier to access. Hell, even if they don't have a car, the government will pay for a van to bring them to their appointment!

It's up to the doctor. My GP has what's called 'same-day-appointments' but some GPs prefer to book appointments in advance to balance their workload.

The point remains that making people responsible for their own healthcare is the surest way to reduce utilization and therefore begin decrease costs.

Yes, and this is a very studied hypothesis. There are competing models that have been tested, as you can imagine. Does a copay deter frivolous visits? Certainly. It also costs money to process and most importantly - deters legitimate visits. Consequently, copays appear to increase overall costs by reducing preventive opportunities while increasing avoidable emergency visits. It generates frictional cost shifting and deferral, without really reducing costs.

So, this is the problem. It's like a lot of things skeptics deal with: 'common sense' may be unreliable here. It would seem that copays should reduce costs. But the resarch shows that they inflate costs dramatically, which is why they're not sustained here in Canada very long.

(Every once in awhile a politician thinks he's the genius who just thought about copays and that it will reduce costs to introduce a flat charge of, say, $10 for a visit. Then costs increase and he has to be educated about this. Again and again and again, over and over and over. Such is the life of skeptics.)

Point is: some of this delivery model's benefits are counterintuitive, like may aspects of economics.

This is why it's easy to 'sell' to the public. It 'makes sense' even though it's not empirically true. Instinctively, we assume there is no free lunch. But management can be considered a technology, and single payer is the newer tech that the US is not upgrading to for various reasons (ideology, protection of profits, &c).

 

[Kestrel]

Statistics show that accessibility to primary care is actually worse in the US than in Canada or the UK. ie: longer waits in the US for GP.

The insurance plans many Americans have require them to visit only doctors and clinics approved by the insurance companies. I once drove past four walk in clinics to get to the nearest one that on my insurance companies approved list.

 

[bookitty]

Don't know about any of the other issues you raise, but are you sure about this part? I really don't know how to find statistics on this but anecdotally most people I know here really do not go to the doctor very often. It is more common for people to express a wish not to bother the doctor, and this is because we know they are busy and that minor stuff gets better by itself or with over the counter stuff. I don't think the decision to visit a doctor is much influenced by the lack of direct cost here.

You may be right but it is honestly not my impression: though the culture may well produce different results in the two countries, for all I know.

In Spain, my husband was able to get antibiotics for a sinus infection from the pharmacy without a prescription. In the UK, I was able to buy medicine in Boots that worked on a migraine. (some combo of codeine and acetaminophen) In both case the pharmacist was incredibly helpful, asked a bunch of questions and made recommendations. (It was bizarre to be waved to the front counter to buy codeine, though.)

I'm from the US. Maybe I was just overly impressed with the idea of walking into a shop, explaining a non-serious/chronic medical issue and having it taken care of for the cost of the medicine. If people are expected to take care of themselves first and then to go see a doctor, wouldn't there be less restrictions on which drugs are available?

 

[sgtbaker]

Nothing is free in the US.

1. When I had day surgery, and was getting ready to leave, the nurse told me to take the crappy, disposable pillows (not the linens) and plastic drinking cup, as I was being charged for them.

2. A friend was in an ER for her child; she had an infant in tow who was fussing. A kindly RN asked her if she would like a pacifier for the baby. She said sure, thanks. It was a $20 pacifier.

3. I had some blood work done. The charges were $800. My health insurance discounted it twice--they used a secondary insurer so that the final cost was $150-- of which they paid 80% (I had not reached my out-of-pocket). Had I not had insurance, I would have owed the lab $800.

No kidding, I had to take my infant daughter to the emergency room because, while I was changing her diaper, my nicotine patch fell off and stuck to her. They didn't/couldn't do anything but watch her for a few hours and by that I mean they came in every hour and checked her heart beat. With no insurance, I got the bill which came to $1016; $1000 for the use of the room for 4hrs and $4 per glove, every time the nurse came in to check her heart. For that price, I could have stayed at the Waldorf Astoria and at least had something to eat.

 

[blutoski]

I'd just add to Fiona's post that possibly because in the UK, the vast majority of healthcare is paid for out of taxes, I can't imagine that many people would think that going to the doctor could be a freebie. In the US, I'd imagine most people would be very aware of getting something for free, that costs other people a fair bit up front.

I can imagine that in the UK, there are certain people who do go to the doctor too often, but I'd guess they either need education, or some other support.

The economics of this has been studied, and healthcare does have a demand curve. But its elasticity is complex, and it seems that people who are going to overvisit need a big deterrence compared to the thresholds for undervisiting.

What happens with copays is that their economic value of reducing unnecessary visits seems to get largely sucked up by administrative overhead. Do we want to charge a copay for vaccinations. Probably not, so there's an exemption. Eventually, there's an exemption schedule with 900 scenarios where part or all of a copay is waived and the benefits start to evaporate.

A simpler solution would be to charge for what the doctor determines was an unnecessary visit, or to refuse to see patients whose visit is not merited. My wife has 'fired' patients when it's clear they're malingering. It's easier for her as a psychiatrist, as she can just close a file. A GP will have to consider other strategies.

In some parts of Canada, remuneration is through capitation. The GPs will consider counseling and educating their patient portfolio about what is and is not something that would require a visit to the doctor. On a higher level, in BC, the Ministry does this level of 'Do I really need to visit the GP over this?' education through a free booklet, tollfree#, website: http://www.healthlinkbc.ca/

As jimbob says: patients are responsible for their care - single pay can be set up to support GPs with giving them the tools they need.

 

[jimbob]

In some parts of Canada, remuneration is through capitation. The GPs will consider counseling and educating their patient portfolio about what is and is not something that would require a visit to the doctor. On a higher level, in BC, the Ministry does this level of 'Do I really need to visit the GP over this?' education through a free booklet, tollfree#, website: http://www.healthlinkbc.ca/

I've seen similar NHS publications. And ones explaining that antibiotics don't work on most (viral) sore throats.


Of course the French have what seems* like a disincentive to getting needless drugs...



...Except that the figures I have seen is that they spend more on drugs than most European nations, so I suppose there is a demand for suppositories.




*to most Brits AFIK...

 

[Architect]

Hmmm... thanks for that. I only know what I hear about and you know how that goes. I'm thinking that it's definitely more cultural. My experience in the US is that the less a person is responsible for the cost of their healthcare, the more they utilize healthcare.

As others have said, that doesn't seem to be the experience in the UK.

Incidentally, our local GP surgeries offer same-day appointments. Home visits can be arranged quickly for more serious complaints. On the NHS. I've never had a problem getting one for myself or the kids, nor do I find the waiting room exactly crowded out with malingerers.

I can see that there might be a lot of benefits to going to a completely socialized medicine model. But it can't be a hybrid. It has to be equal access for all. Somehow, however, I doubt this is the case in actual practice in the UK and other places with socialized medicine. For example, is it possible to pay for a service yourself if the government denies the service? If so, then the rich still have better access to care and the poor are still denied services that might extend/better their lives, even if a government bean counter doesn't think it's worth it. So the system may cost less for the government to run, but can you really say it's gives all citizens equal access to medical care?

I think there are a number of issues you need to be aware of here. It's a complex issue, though, and I'm not sure I can do it justice.

Firstly, you need to be aware that the NHS covers more or less all medically essential treatment at standards comparable to those typically found in the American healthcare system. There is some modest prioritisation - you may have to wait a few months to get some iffy cartilidge in your knee attended to - but the horror stories presented by the US right-wing media are.....misleading.

The only things that don't tend to get covered are cosmetic and elective treatments - think tattoo removal and the like. In contrast IVF is covered (although the criteria vary within the UK).

Clinical standards are monitored centrally and when someone drops significantly below par (as does happen) then it's widely reported, there's a huge public outcry, and so on. Likewise waiting lists for the non-essential work is monitored and published.

Secondly, most medical practitioners in the UK - consultants and surgeons - are employed by the NHS (usually ona contract basis) and do the private work out of hours hence it's not really a case of A list and B -list doctors. If you elect to pay then you can choose your surgeon, but in reality there's not a lot to choose between them for many treatments.

Thirdly, nearly all acute treatment is provided by the NHS with the private sector providing cover largely for elective surgery and cosmetic procedures not covered by the NHS (think tattoo removal again). I can use the private sector to knock some time off a wating list for the dodgy cartildge or get my second cataract done more quickly, and that's most of its work.

I could be wrong but I can only think of one private hospital in Scotland - Ross Hall, in Glasgow - which has an intensive care unit, for example.

For example, a poor man who is alcoholic needs a new liver, but the government denies it because it isn't cost effective to give an alcoholic a new liver. He dies 6 months later. A rich man will also be denied the transplant, but he can simply pay for it out of his own pocket. He gets to live another 10 years or more. Even if it isn't allowed by law, he can still travel to another country where it is allowed.

Well we can't stop someone travelling abroad if he wishes. But when it comes to selection for transplant programmes in the UK then common selection criteria apply. You can't get first dibs just because you;ve got private coverage.

Fellow Brits will remember the fuss over alcoholic ex-footballer George Best getting a new liver on the NHS and the soul-serching which took place. It didn't help, of course, the damned idiot kept drinking.

Honestly, I don't know enough about the systems in other countries because I'm too focused on making the one in my country work better for my clinic. I'm open to hearing more about how socialized medicine actually works.

I would suggest that looking at other systems is one way of identifying ways in which your own system might be improved.

On a linked note, I've told the story here before about my own fun & games back at Xmas 2006. I think it demonstrates the NHS at its best.

Minor knee op a week beforehand, but woke up on Xmas day with severe shortness of breath, aches, and a fever. Assumed it was sudden flu but called the on-call doctor service at 10.45am. Given an appointment to see them at 11.15 (they offered 11 but I had to dress). Ambulance offered if I needed it, but father able to pop around and run me the 2 miles to the on-call offices.

Arrived at surgery, quick examination, medical records already available and noted recent op plus sister with a previous thrombosis. Told precautionary approach required given risk of clot and immediately transferred to hospital. By 11.30 or thereby was hooked up to a heart momitor, permanent nurse supervision. The latter bit was worrying, as it suggested ow serious they were taking it. There was even a macine that went "beep" and everything.

By about 1.30pm they decided it was probably pneumonia with pleurisy but were sufficiently worried by proximity to op and sister's history that was admited to the emergency ward for 24 hour supervision. Senior on-call doctor popped by to check with the nurse every 45 minutes or so.

Boxing day was given a full ultrasound scan to look for clots. Consultant pulled from his day off to give me the once over (they all have to stay witin 15-20 minutes of their hospital anyway). Moved into general ward for treatment for pneumonia for 2-3 days. Only problem there was it was a six person ward and some of the others snored rather a lot....


Right in the middle of this my American sister-in-law came to visit me (she was over for Xmas). I remember her looking around the emergency ward and complaining that I had to share it with another patient. Said she "wouldn't be happy paying for this". Gobsmacked to find that I wasn't.

We have private medical insurance. Wife works for a multinational and it comes as a free perk at her grade. Didn't use it. Would have received the same treatment, in the same hospital. But admittedly in a private room once I was moved to the general ward. And frankly I can live with the snoring.

 

[blutoski]

The insurance plans many Americans have require them to visit only doctors and clinics approved by the insurance companies. I once drove past four walk in clinics to get to the nearest one that on my insurance companies approved list.

Yes, this is where I was hesitant to bring up personal anecdotes, because they don't prove much.

But I have a doozie! When I worked in a factory in Richmond BC, the fellow who maintained our machines was a contractor working for an American company. He lived in Point Roberts just across the border.

As you can imagine, he sawed his thumb halfway off. We called his HMO helpline and I ultimately drove him partway to Seattle to find a hospital covered by his plan.

The point is not that I had to drive him to the US (he was mentally prepared for that), but that we must have passed eleven US-located nonqualifying emergency rooms on the way. I calculate about 5 hours' extra driving, since the Point Grey clinic would have been 10 minutes away.

I know many HMOs have reciprocal arrangements that expand the inventory of qualifying facilities, but why should it be that complicated?

 

[Emet]

I have to say, this thread has made me sick. (Doctor, Doctor!)

I live in the US; I have a "Cadillac" health insurance plan.

But the US health care system stinks. And too many Americans either don't seem to know or don't seem to care. Maybe, just maybe, if the new health care overhaul bill isn't gutted, and is improved over time, in the next 50 years we'll catch up to everyone else.

Alas, I am not optimistic.

 

[bigred]

Smaller wonder. There's little reason for it IMO.

What really it blowing my mind is that this doesn't get any better for more serious areas...like oh say cancer centers where incompetence/apathy can make a diff in someone living or not. From the glorified secretarial goons to the nurses and doctors themselves, it's extremely scary.

 

[Beth]

My impression is that the market price of a service is very elastic, and billing will start high and reprice down to the maximum obtainable from the customer.

Unfortunate story: my friend's relative was visiting the US and was in a car collision (passenger). Hit-and-run, unfortunately. Minor head injury and some broken bones by the sound of it. Ambulance, minor surgery. Hospital for a few days. Her bill upon returning to Calgary was $350,000.

The unfortunate part is that the province won't cover full cost for charges outside the US, and she did not have the foresight to obtain travel insurance. She has no idea what's going to happen. At this point, she's shopping around for legal advice.

Medical expenses are one of the leading causes of bankrupcy in the U.S. Unfortunately, plenty of those people filing for bankrupcy had insurance!

The point remains that making people responsible for their own healthcare is the surest way to reduce utilization and therefore begin decrease costs.

I think this is a great point. I hadn't thought of that connection, but it makes sense.

I have to say, this thread has made me sick. (Doctor, Doctor!)

I live in the US; I have a "Cadillac" health insurance plan.

But the US health care system stinks. And too many Americans either don't seem to know or don't seem to care. Maybe, just maybe, if the new health care overhaul bill isn't gutted, and is improved over time, in the next 50 years we'll catch up to everyone else.

Alas, I am not optimistic.

Alas, I feel the same.

 

[Fiona]

I think this is a great point. I hadn't thought of that connection, but it makes sense.

Well as others have pointed out, it is not really a great point because it does not seem to be true. The problem that I see with this is that it it is predicated on assumptions which are not actually examined because they fit with a view of human behaviour which is embedded in ideology more than in observation.

I recognise that it is complicated. Cultural differences may well be in play: but those cultural differences don't come from nowhere. At a guess (and it is a guess) I would suggest that the mindset in this counry is partly a hangover from a time when medicine was private: and partly a consequence of the notion that the NHS is a benefit for us all and is not to be abused.

There are certainly some people who will see a doctor when there is no real need to do that: those people will exist everywhere and will have a variety of reasons for doing so: for example some people are apt to "be sure" if a child is ill, and I think that increases when there is a lot of press coverage about meningitis or the like. Not sure that is a bad thing, though. There are hypochondriacs, for want of a better term, and they will probably use the doctor more. Whether it can be argued that they are ill, but not in the way they think they are, is moot. Doctors probably don't have time or expertise to tackle the underlying problem but a referral for counselling or psychiatric support is there if it is judged that would help.

The fact remains that such people are really not very common and I do not see any reason to believe that they are influenced by the absence of direct costs. People are not solely motivated by money no matter what the ideologues would have you believe: a true hypochondriac might well prioritise those costs in his or her budget simply because they are like most of the rest of us: they prioritise their health.

What is necessary is also culturally influenced so far as I can see: for example I had a discussion in chat with some americans who took something called "strep throat" seriously and saw that as a condition which would always benefit from seeing a doctor. As that is not a condition I have ever even heard of I googled a bit. Doesn't seem to be particularly serious and it gets better by itself. Some sore throats need antibiotics because they are really sore and persistent: most dont and don't in fact get better any quicker with antibiotics. But if you believe that untreated sore throats quite often turn into something much more serious you are more likely to visit the doctor. I don't believe that and the people I was chatting with do. That is the difference on that one anecdotal instance. I do not mean to crtiticise because it seems to me that the whole health situation in america has the consequence than in general the americans are a lot more educated on health matters than we are: but still they are not always correct. The information they get is not always unbiased either.

 

[Bob001]

Other systems...

[FONT=Tahoma, sans-serif]A PBS special, "Sick Around the World," is an entertaining and informative look at five national health care systems around the world by a former Washington Post reporter who has also written a book about the subject. Some systems are government-run, others are based on private insurance, but all deliver good care efficiently. One key number that sticks in my mind: In the U.S., around 24% of health care money goes directly to administrative costs; in other systems, administration is down to as little as 6%. (This is an hour-long program, divided into five chapters, but it's worth watching when you have the time.)[/FONT]
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/view/#morelink

[FONT=Tahoma, sans-serif][/FONT] [FONT=Tahoma, sans-serif]
[/FONT]

 

[Bob001]

...What is necessary is also culturally influenced so far as I can see: for example I had a discussion in chat with some americans who took something called "strep throat" seriously and saw that as a condition which would always benefit from seeing a doctor. As that is not a condition I have ever even heard of I googled a bit. Doesn't seem to be particularly serious and it gets better by itself. Some sore throats need antibiotics because they are really sore and persistent: most dont and don't in fact get better any quicker with antibiotics. But if you believe that untreated sore throats quite often turn into something much more serious you are more likely to visit the doctor. I don't believe that ...

From the Mayo Clinic web site (it is one of the most prestigious hospitals in the U.S.), emphasis added:

"Strep throat is a bacterial throat infection that can make your throat feel sore and scratchy. Compared with a viral throat infection, strep throat symptoms are generally more severe. Only a small portion of sore throats are the result of strep throat. It's important to identify strep throat for a number of reasons. If untreated, strep throat can sometimes cause complications such as kidney inflammation and rheumatic fever. Rheumatic fever can lead to painful and inflamed joints, a rash and even damage to heart valves. Strep throat is most common between the ages of 5 and 15, but it affects people of all ages. If you or your child has signs or symptoms of strep throat, see your doctor for prompt treatment."
http://www.mayoclinic.com/health/strep-throat/DS00260

A "sore throat" is not the same as strep throat, and as a matter of fact strep throat can lead to something much more serious, especially in children. That's why everybody needs access to medical care.